Department of Nephrology and Laboratory of Kidney Disease, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.
Department of Skin, Hunan Provincial People's Hospital, The First Affiliated Hospital of Hunan Normal University, Changsha, China.
Blood Purif. 2024;53(4):288-300. doi: 10.1159/000535244. Epub 2023 Nov 16.
This study aimed to evaluate the characteristics and prognostic factors for coronavirus disease 2019 (COVID-19) patients on maintenance hemodialysis (HD).
All admitted HD patients who were infected with SARS-CoV-2 from December 1, 2022, to January 31, 2023, were included. Patients with pneumonia were further classified into the mild, moderate, severe, and critical illness. Clinical symptoms, laboratory results, radiologic findings, treatment, and clinical outcomes were collected. Independent risk factors for progression to critical disease and in-hospital mortality were determined by the multivariate regression analysis. The receiver operating characteristic analysis with the area under the curve was used to evaluate the predictive performance of developing critical status and in-hospital mortality.
A total of 182 COVID-19 patients with HD were included, with an average age of the 61.55 years. Out of the total, 84 (46.1%) patients did not have pneumonia and 98 (53.8%) patients had pneumonia. Among patients with pneumonia, 48 (49.0%) had moderate illness, 26 (26.5%) severe illness, and 24 (24.5%) critical illness, respectively. Elder age [HR (95% CI): 1.07 (1.01-1.13), p <0.01], increased levels of lactate dehydrogenase (LDH) [1.01 (1.003-1.01), p <0.01], and C-reactive protein (CRP) [1.01 (1.00-1.01), p = 0.04] were risk factors for developing critical illness. Elder age [1.11 (1.03-1.19), p = 0.01], increased procalcitonin (PCT) [1.07 (1.02-1.12), p = 0.01], and LDH level [1.004 (1-1.01), p = 0.03] were factors associated with increased risk of in-hospital mortality.
Age, CRP, PCT, and LDH can be used to predict negative clinical outcomes for HD patients with COVID-19 pneumonia.
本研究旨在评估接受维持性血液透析（HD）的 2019 冠状病毒病（COVID-19）患者的特征和预后因素。
纳入 2022 年 12 月 1 日至 2023 年 1 月 31 日期间感染 SARS-CoV-2 的所有入院 HD 患者。将肺炎患者进一步分为轻症、中度、重症和危重症。收集临床症状、实验室结果、影像学表现、治疗和临床结局。通过多变量回归分析确定向重症疾病和院内死亡进展的独立危险因素。采用曲线下面积的受试者工作特征分析评估发生重症状态和院内死亡的预测性能。
共纳入 182 例 COVID-19 合并 HD 患者，平均年龄为 61.55 岁。其中 84 例（46.1%）患者无肺炎，98 例（53.8%）患者有肺炎。在肺炎患者中，分别有 48 例（49.0%）为中度疾病，26 例（26.5%）为重症疾病，24 例（24.5%）为危重症疾病。年龄较大[风险比（95%置信区间）：1.07（1.01-1.13），p <0.01]、乳酸脱氢酶（LDH）水平升高[1.01（1.003-1.01），p <0.01]和 C 反应蛋白（CRP）[1.01（1.00-1.01），p = 0.04]是发展为危重症的危险因素。年龄较大[1.11（1.03-1.19），p = 0.01]、降钙素原（PCT）[1.07（1.02-1.12），p = 0.01]和 LDH 水平[1.004（1-1.01），p = 0.03]升高与 HD 合并 COVID-19 肺炎患者的住院死亡率增加相关。
年龄、CRP、PCT 和 LDH 可用于预测 COVID-19 肺炎 HD 患者的不良临床结局。
